Modified Kigali Combined Staging Predicts Risk of Mortality in HIV-Infected Adults in Lusaka, Zambia

Authors

Philip J. Peters, Emory University
Isaac Zulu, University Teaching Hospital
Nzali G. Kancheya, University Teaching Hospital
Shabir Lakhi, University Teaching Hospital
Elwyn Chomba, University Teaching Hospital
Cheswa Vwalika, Zambia-Emory HIV Research Project
Dhong-Jin Kim, University of Alabama - Birmingham
Ilene Brill, University of Alabama - Birmingham
Jareen Meinzen-Derr, Children’s Hospital Medical Center
Amanda Tichacek, Emory University
Susan A. Allen, Emory University

Document Type

Article

Date of this Version

2008

Comments

Published in AIDS RESEARCH AND HUMAN RETROVIRUSES, Volume 24, Number 7, 2008, © Mary Ann Liebert, Inc., Used by Permission DOI: 10.1089/aid.2007.0297

Abstract

We assessed the utility of the modified Kigali combined (MKC) staging system for predicting survival in HIV-infected Zambian adults in a prospective, longitudinal, open cohort. From 1995 to 2004, HIV-discordant couples (one HIV-infected partner and one HIV-negative partner) were recruited from couples’ voluntary counseling and testing centers in Lusaka, Zambia and followed at 3-month intervals. MKC stage, which incorporates clinical stage with erythrocyte sedimentation rate (ESR), hematocrit, and body mass index (BMI), was determined at enrollment. Kaplan–Meier survival and Cox proportional hazard methods were used to calculate median survival and relative hazards. We enrolled 1479 HIV-discordant couples with a combined 7305 person years of follow-up. Among HIV-infected participants over the 9-year study period, there were 333 confirmed deaths. The time to 50% mortality was 8.5 years with MKC stage 1 and 2 disease compared to 3.7 years with MKC stage 4 disease at enrollment. Survival rates at 3 years were 85% with MKC stage 1 and 2 disease, 74% with MKC stage 3 disease, and 51% with MKC stage 4 disease. A total of 275 HIV-negative partners seroconverted during follow-up. In comparison, survival rates at 3 years were 94% for HIV-negative participants and 92% for participants who seroconverted during follow-up. In multivariate analysis, MKC stage 4 disease (HR = 3.7, 95% CI = 2.7–5.0) remained a strong predictor of mortality. Incorporating ESR, hematocrit, and BMI with clinical staging is a powerful, low-cost tool to identify HIV-infected adults at high risk for mortality.